HELPING SMOKERS MAKE DECISIONS - THE ENHANCEMENT OF BRIEF INTERVENTION FOR GENERAL MEDICAL-PRACTICE

Primary care clinicians are often encouraged by government agencies to intervene systematically with all smokers. Pressure of time and pessi mism about their own efficacy and patients' capacity to change are som e of the reasons why clinicians do not feel it is appropriate to alway s advise every patient about unhealthy behaviour. Developments in pati ent centred approaches to the consultation and progress in the addicti ons field suggest that new consulting methods could be constructed whi ch are more satisfying than giving brief advice to change. The aim of this study was to develop a structured, teachable and acceptable inter vention for clinicians to help patients consider their smoking during general medical consultations. Patient centred strategies derived from the stages of change model and motivational interviewing and its adap tations were explored in experimental consultations with 20 volunteer smokers. Feedback from them and from general practice registrars train ed in the use of the method informed its development. Acceptability to clinicians was assessed by semi structured telephone interviews with 24 general practice registrars who participated in a randomised contro lled trial assessing the effectiveness of the method. Anonymous, writt en questionnaires were also completed by 20 of the registrars who recr uited ten or more patients into the trial. The method is described. Ke y components are: establishing rapport, assessing motivation and confi dence, and then depending on the response, asking standard scaling que stions, asking about pros and cons of smoking, non-judgmental informat ion sharing, brainstorming solutions and negotiating attainable goals and follow-up, The clinicians used the method with a total of 270 smok ers, taking an average of 9.69 min with each patient. Evaluation revea ls that it is acceptable to the group of general practice registrars. Longer consultation time was seen as the main drawback. We conclude th at acceptable methods for opportunistic health promotion can be develo ped by taking into account patient centred approaches to the consultat ion, developments from the addictions field and the practical problems faced by clinicians. The process can be further enhanced by consideri ng feedback from those who are likely to receive and use the intervent ions. (C) 1997 Elsevier Science Ireland Ltd.